Preoperative Biliary Drainage: Methods, Advantages, and Complications

Malignant biliary obstruction is very difficult to treat; only 10–20% of the patients are suitable for curative resections. Obstructive jaundice is associated with a pro-inflammatory state, altering the normal physiology and affecting multiple organ systems. So, patients with malignant obstructive jaundice are at increased risk of postoperative complications. Nevertheless, the preoperative biliary drainage (PBD) remains controversial, because the procedures themselves can be associated with septic and other complications. The main therapeutic options for PBD in malignant biliary obstruction are percutaneous biliary drainage and endoscopic biliary drainage. The knowledge of the approaches, their advantages, and complications are essential for the management of patients with pathologies that produce biliary obstruction such as bile duct cancer. The aim of this chapter is to review the methods for biliary drainage and its indications, advantages, and complications

Silver carp (Hypophthalmichthys molitrix) present in a section of the Balsas riverbed in the Tierra Caliente region

Se logró conocer la biología de Hypophthalmichthys molitrix a pesar de estar carente de literatura, y solo es mencionada junto con otras especies de carpas, las claves dicotómicas fueron fundamentales para que no exista margen de error y confusión sobre la especie que se investigó. Las encuestas reportadas brindan respuestas positivas, ya que Hypophthalmichthys molitrix cuenta con una gran importancia en la Región calentana, y con el paso del tiempo un atractivo de consumo para todos y cada uno de los habitantes de dicha región. De acuerdo a su aparición, todos concuerdan que Hypophthalmichthys molitrix llego de forma accidental a los ríos de la Región Tierra Caliente, lo cual la hace una especie invasora y literalmente estas especies traen consigo negatividad ecológica pero actualmente las investigaciones dicen lo contrario y no existe riesgo alguno de causar estragos con otras especies que habitan en los ríos calentanos. Las condiciones comparadas con literatura y presentes en la región calentana, muestran posibilidades de reproducción, además de ser una especie invasora posee adaptación rápida. It was possible to know the biology of Hypophthalmichthys molitrix despite the lack of literature, and it is only mentioned together with other species of carp. The dichotomous keys were essential so that there was no margin of error and confusion about the species that was investigated. The surveys reported provide positive responses, since Hypophthalmichthys molitrix has great importance in the Calentana Region, and over time an attractive consumption for each and every one of the inhabitants of said region. According to its appearance, everyone agrees that Hypophthalmichthys molitrix accidentally arrived in the rivers of the Tierra Caliente Region, which makes it an invasive species and these species literally bring with them ecological negativity but currently research says the opposite and there is no risk. some of wreaking havoc with other species that live in the Calevano rivers. The conditions compared to literature and present in the Calenta region show possibilities of reproduction, in addition to being an invasive species, it has rapid adaptation and is a plus point for which it has a great future

PEG-copolymer-coated iron oxide nanoparticles that avoid the reticuloendothelial system and act as kidney MRI contrast agents

In vitro experiments have shown the great potential of magnetic nanocarriers for multimodal imaging diagnosis and non-invasive therapies. However, their extensive clinical application is still jeopardized by a fast retention in the reticuloendothelial system (RES). The other issue that restrains their potential performance is slow degradation and excretion, which increases their risks of toxicity. We report a promising case in which multicore iron oxide nanoparticles coated with a poly(4-vinylpyridine) polyethylene glycol copolymer show low RES retention and high urinary excretion, as confirmed by single photon emission computerized tomography (SPECT), gamma counting, magnetic resonance imaging (MRI) and electron microscopy (EM) biodistribution studies. These iron oxide-copolymer nanoparticles have a high PEG density in their coating which may be responsible for this effect. Moreover, they show a clear negative contrast in the MR imaging of the kidneys. These nanoparticles with an average hydrodynamic diameter of approximately 20 nm were nevertheless able to cross the glomerulus wall which has an effective pore size of approximately 6 nm. A transmission electron microscopy inspection of kidney tissue revealed the presence of iron containing nanoparticle clusters in proximal tubule cells. This therefore makes them exceptionally useful as magnetic nanocarriers and as new MRI contrast agents for the kidneys.Financial support by the Spanish Ministry of Science and Innovation (MAT2014-52069-R) (SAF2014-53413-R) (PC2015-1-05 (53-80)) is gratefully acknowledged.Peer reviewe

Cuerpo extraño inusual en recto como causa de obstrucción intestinal, Reporte de un caso.

The rectum, the penultimate portion of the large intestine, tends to be of special interest due to so-called anorectal emergencies, which are defined as “a wide variety of conditions that share common symptoms, such as anorectal pain or bleeding, which may require immediate management." These emergencies are considered a public health problem that result in a large economic expense, time, medications, days of working life and culmination of quality of life. The presence of a foreign body in the rectum constitutes a challenge for the surgeon. This pathology shows a wide predisposition for the male gender with a peak in its presentation between 20 and 40 years, being the main etiology of a sexual nature, which is why patients often tend to avoid seeking help for fear of being judged. We present the case of a 33-year-old man, with a history of chronic alcoholism, in the process of rehabilitation admitted to a clinic, where he was referred for presenting abdominal pain, vomiting on numerous occasions, and inability to evacuate for 3 days. , in addition to transanal bleeding in a mild to moderate amount, fetid, dark liquid, a simple and contrast-enhanced tomography is performed, showing the presence of impaction at the level of the rectal ampulla of apparent "bird bones", which is corroborated after directed questioning and rectal exploration with extraction of some pieces. He is admitted to the operating room where the foreign body is extracted under regional anesthesia and instrumentation, he is hospitalized and managed with laxatives, he is discharged after 4 days due to improvement.El recto, la penúltima porción del intestino grueso, tiende a ser de especial interés debido a las denominadas urgencias anorrectales, las cuales se definen como “una amplia variedad de enfermedades que comparten síntomas en común, como son dolor anorrectal o sangrado, las cuales pueden requerir de manejo inmediato”. Estas urgencias, son consideradas un problema de salud pública que derivan en un gran gasto económico, tiempo, medicamentos, días de vida laboral y afectan la calidad de vida. La presencia de un cuerpo extraño en el recto constituye un reto para el cirujano. Esta patología muestra una amplia predisposición por el género masculino con un pico en su presentación entre los 20 y 40 años, siendo la principal etiología de índole sexual por lo que muchas veces los pacientes tienden a evitar el buscar ayuda por miedo a ser juzgados. Se presenta el caso de un hombre de 33 años de edad, con antecedente de alcoholismo crónico, en proceso de rehabilitación internado en una clínica, de donde es referido por presentar dolor abdminal, vòmito en numerosas ocasiones e incapacidad para evacuar de 3 días de evolución, además de sangrado transanal en cantidad leve a moderada, fétida, líquida oscura, se realiza tomografía simple y contrastada que muestra la presencia de impactación a nivel de ámpula rectal de aparentes ”huesos de pollo”, el cual se corrobora tras el interrogatorio dirigido y la exploración rectal con extracción de algunas piezas. Es ingresado a sala de quirófano donde se extrae bajo bloqueo regional y con instrumentación el cuerpo extraño, es hospitalizado y manejado con laxantes, se egresa a los 4 días por mejoría

UPMSat-2 Micro-Satellite: In-orbit Technological Demonstration for Education and Science

The UPMSat-2 micro-satellite was launched on September the 3rd 2020 at 01:51:10 UTC from Kourou spaceport in French Guyana. The VV16 Vega Flight has been the first low Earth orbit rideshare commercial flight with a total of 53 satellites (7 of them micro-satellites) to be released by the launch vehicle, arranged in the modular SSMS (Small Spacecraft Mission Service) dispenser. UPMSat-2 is an educational, scientific and in-orbit technological demonstration microsatellite project led by the IDR/UPM research institute from Universidad Politécnica de Madrid (UPM), Spain. This mission can be considered as a logical extension of the IDR/UPM Institute activities focused on designing small satellites to be used as educational platforms of first level. Thereby, UPMSat-2 (as well as its precursor, the UPMSat-1) has the main objective to give students the competences for designing, analyzing, manufacturing, integrating, testing and operating the platform. UPMSat-2 also includes a set of scientific payloads and equipment to be tested in space, provided by research institutions and private companies. The UPMSat-2 is a 50 kg-class microsatellite developed for a 2-year LEO mission with a geometrical envelope of 0.5 x 0.5 x 0.6 m. Since launch, the satellite is orbiting the Earth in a sun-synchronous orbit of 500 km of altitude, passing over the IDR/UPM ground station four times a day. The satellite operation is being carried out by students and professors of the Master in Space Systems (MUSE), an official Master’s program of UPM organized by IDR/UPM. This work describes the most relevant characteristics of UPMSat-2, its payloads, technological contributions, and the main activities performed up to the launch, including participation in the launch campaign in French Guyana. The lessons learned during the mission are also summarized. Finally, the importance and benefits of incorporating actual space systems design and development within academic programs is also emphasized, as it improves these programs with constant and direct feedback

Los concheros de La Fuente: consideraciones metodológicas y resultados preliminares

Presentamos un estudio preliminar del Conchero de El Tinajero, que forma parte del Conjunto Arqueológico La Fuente (Buenavista del Norte). Aportamos los datos para su caracterización arqueológica y su explicación histórica en el contexto de las actividades productivas de los guanches.We show a preliminary study of the Conchero de El Tinajero which is part of the state archaelogist La Fuente (Buenavista del Norte). We bring forward the facts to the archaeologist typify and the historical explain on the context of guanches’ productive activities

The Latin American experience of allografting patients with severe aplastic anaemia: real-world data on the impact of stem cell source and ATG administration in HLA-identical sibling transplants

We studied 298 patients with severe aplastic anaemia (SAA) allografted in four Latin American countries. The source of cells was bone marrow (BM) in 94 patients and PBSCs in 204 patients. Engraftment failed in 8.1% of recipients with no difference between BM and PBSCs (P = 0.08). Incidence of acute GvHD (aGvHD) for BM and PBSCs was 30% vs 32% (P = 0.18), and for grades III–IV was 2.6% vs 11.6% (P = 0.01). Chronic GvHD (cGvHD) between BM and PBSCs was 37% vs 59% (P = 0.002) and extensive 5% vs 23.6% (P = 0.01). OS was 74% vs 76% for BM vs PBSCs (P = 0.95). Event-free survival was superior in patients conditioned with anti-thymocyte globulin (ATG)-based regimens compared with other regimens (79% vs 61%, P = 0.001) as excessive secondary graft failure was seen with other regimens (10% vs 26%, P = 0.005) respectively. In multivariate analysis, aGvHD II–IV (hazard ratio (HR) 2.50, confidence interval (CI) 1.1–5.6, P = 0.02) and aGvHD III–IV (HR 8.3 CI 3.4–20.2, Po0.001) proved to be independent negative predictors of survival. In conclusion, BM as a source of cells and ATG-based regimens should be standard because of higher GvHD incidence with PBSCs, although the latter combining with ATG in the conditioning regimen could be an option in selected high-risk patient

Usefulness of bone turnover markers as predictors of mortality risk, disease progression and skeletal-related events appearance in patients with prostate cancer with bone metastases following treatment with zoledronic acid: TUGAMO study

Owing to the limited validity of clinical data on the treatment of prostate cancer (PCa) and bone metastases, biochemical markers are a promising tool for predicting survival, disease progression and skeletal-related events (SREs) in these patients. The aim of this study was to evaluate the predictive capacity of biochemical markers of bone turnover for mortality risk, disease progression and SREs in patients with PCa and bone metastases undergoing treatment with zoledronic acid (ZA). Methods: This was an observational, prospective and multicenter study in which ninety-eight patients were included. Patients were treated with ZA (4mg every 4 weeks for 18 months). Data were collected at baseline and 3, 6, 9, 12, 15 and 18 months after the beginning of treatment. Serum levels of bone alkaline phosphtase (BALP), aminoterminal propeptide of procollagen type I (P1NP) and beta-isomer of carboxiterminal telopeptide of collagen I (b-CTX) were analysed at all points in the study. Data on disease progression, SREs development and survival were recorded. Results: Cox regression models with clinical data and bone markers showed that the levels of the three markers studied were predictive of survival time, with b-CTX being especially powerful, in which a lack of normalisation in visit 1 (3 months after the beginning of treatment) showed a 6.3-times more risk for death than in normalised patients. Levels of these markers were also predictive for SREs, although in this case BALP and P1NP proved to be better predictors. We did not find any relationship between bone markers and disease progression. Conclusion: In patients with PCa and bone metastases treated with ZA, b-CTX and P1NP can be considered suitable predictors for mortality risk, while BALP and P1NP are appropriate for SREs. The levels of these biomarkers 3 months after the beginning of treatment are especially importantThis study was supported by Novartis Oncology Spai

Guía clínica para el diagnóstico y seguimiento de la distrofia miotónica tipo 1, DM1 o enfermedad de Steinert

La enfermedad de Steinert o distrofia miotónica tipo 1 (DM1), (OMIM 160900) es la miopatía más prevalente en el adulto. Es una enfermedad multisistémica con alteración de prácticamente todos los órganos y tejidos y una variabilidad fenotípica muy amplia, lo que implica que deba ser atendida por diferentes especialistas que dominen las alteraciones más importantes. En los últimos anos ˜ se ha avanzado de manera exponencial en el conocimiento de la enfermedad y en su manejo. El objetivo de la guía es establecer recomendaciones para el diagnóstico, el pronóstico, el seguimiento y el tratamiento de las diferentes alteraciones de la DM1. Esta guía de consenso se ha realizado de manera multidisciplinar. Se ha contado con neurólogos, neumólogos, cardiólogos, endocrinólogos, neuropediatras y genetistas que han realizado una revisión sistemática de la literatura. Se recomienda realizar un diagnóstico genético con cuantificación precisa de tripletes CTG. Los pacientes con DM1 deben seguir control cardiológico y neumológico de por vida. Antes de cualquier cirugía con anestesia general debe realizarse una evaluación respiratoria. Debe monitorizarse la presencia de síntomas de disfagia periódicamente. Debe ofrecerse consejo genético a los pacientes con DM1 y a sus familiares. La DM1 es una enfermedad multisistémica que requiere un seguimiento en unidades especializadas multidisciplinares

Asociación entre Artritis Reumatoidea y otras enfermedades autoinmunes

Objetivos: determinar la frecuencia de enfermedades autoinmunes (EAI) en pacientes con Artritis Reumatoidea (AR) y comparar la frecuencia de EAI entre pacientes con AR y sin AR ni otra EAI reumatológica. Material y Métodos: estudio multicéntrico, observacional, analítico, retrospectivo. Se incluyeron pacientes consecutivos con AR (ACR/EULAR 2010) y como grupo control pacientes con diagnóstico inicial de Osteoartritis primaria (OA).